Table 1

Risk assessments: evaluations undertaken by FIFA's Medical Assessment and Research Centre

Risk factorLiterature review (L)/research (R) studyOutcomeAction required
Intrinsic factors
Participant related
AgeComparison of the incidence of injury for male amateur players as a function of age (R)23Incidence of injury increases with age and is highest among senior playersDevelop techniques to determine the age of young players and monitor the age of players competing in age-restricted competitions
Assess whether over-age players take part in age-restricted competitions (R)24Some evidence of overage players taking part in age-restricted competitions
Drugs/medicationExcretion of nandrolone metabolites by amateur and professional players following exercise (R)25Variations in postactivity urine levels of some steroids in non-drug-taking players occur across ethnic groups; results indicate that individual steroid profiling should be considered. High usage of NSAIDs by playersInstigate drug-testing procedures in football to support WADA. Information to team physicians on the side effects of NSAIDs
Steroid profiles in elite footballers (R)26
Evaluate the use of medication during competition (R)27
GenderComparison of incidence and severity of injury for international male and female players (R)28Incidence of injury is higher among male players than among female players but female players are significantly more likely to sustain ACL injuries than menDevelop a prevention programme to reduce the incidence of ACL injuries among female players
Comparison of incidence and severity of injury for amateur male and female players (R)29
Medical historyRisk factor analysis (R)30Previous injury most important risk factor for injury. Players frequently returned to play while still feeling the effects of an injury. Players may have undiagnosed cardiovascular problems when playing high-level footballReview the best practice procedures and develop protocols to evaluate player's medical condition prior to FIFA tournaments
Precompetition musculoskeletal evaluation (R)31
Precompetition cardiovascular assessment (R)32
Psycho-socialImpact of player behaviour on fair play (R)33A wide range of psychosocial factors impacted on players attitudes towards fair playReview FIFA policy towards all aspects of ‘fair play’
Impact of psychological characteristics on fair play (R)34
Standard of playComparison of the incidence of injury at international men's tournaments (R)28For men, the incidence of injury at World Cups lower than the incidences of injury at <17 and <20 tournaments; for women, no clear trendsDevelop an injury prevention programme for players of all skill levels.
Comparison of the incidence of injury at international women's tournaments (R)28
TacklingComparison of risks associated with making different types of tackle by male players (R)35Video analysis of tackles showed that players making a tackle were more likely to be injured when tackles involved a clash of heads or were two-footedReview the laws of the game
Comparison of risks associated with making different types of tackle by female players (R)36
Extrinsic factors
Facility-related
Playing surfaceComparison of the incidence of injury among non-professional players on artificial turf and grass playing surfaces (R)29There were no significant differences in the overall incidence of injury for male and female footballers playing on artificial turf compared with natural grassMaintain quality criteria for FIFA-approved artificial turf pitches
Comparison of the incidence of injury among professional players on artificial turf and grass playing surfaces (R)37
Stadium designAssess the environs of the playing area that may impact on a player's safety (R)38Hazardous situations and objects were found in the environs of the playing areaProduce stadium design guidelines
Equipment-related
Headgear/footballsBiomechanical analysis of protection offered by headgear (R)39No evidence found that commercially available headgear provided a significant level of head protection to players Some evidence that reducing ball size and ball pressure could reduce impact forces during headingReview technical specifications for water uptake of balls
Biomechanical analysis of football properties (R)40
Environment-related
AltitudeEffect of altitude on football performance (L)41Players from low altitude must acclimatise for 1–2 weeks before competing at high altitude to avoid adverse effects on performanceDevelop a statement on playing football at altitude
Preparations for playing football at altitude (L)42
Being tackledComparison of risks associated with different types of tackle on male players (R)35Video analysis of tackles showed that players being tackled were more likely to be injured when the tackles involved a clash of heads or were two-footedReview the laws of the game and the punishments given against players causing severe injuries
Comparison of risks associated with different types of tackle on female players (R)36
Playing positionImpact of playing position on the incidence of injury among male players (R)35No significant difference found in the incidence of injury as a function of playing position for men but forwards and defenders showed higher incidences of injury among female playersNone required
Impact of playing position on the incidence of injury among female players (R)43
RamadanImpact of Ramadan on physical and football performance (R)44Changes in sleep and nutrition patterns during Ramadan had no significant effects on physical performanceProvide advice on nutrition; recommendation that players ensure adequate sleep and nutrition during Ramadan
Influence of Ramadan on physiological parameters (R)45
RefereeingAssess referees' decision-making in player injury situations (R)46Current laws were adequate to protect players from injury but in matches referees were under pressure to make difficult decisions in high pressure situations and match referees often failed to punish players in incidents leading to injuryReview referees training programmes
Stage in matchEffect of stage in match on the incidence of injury in men's football (R)47For men, there were significantly more injuries in the second half of matches than in the first half but for women there were no differences. Effects in the men's game may be caused by fatigueDevelop an injury prevention programme for players of all skill levels
Effect of stage in match on the incidence of injury in women's football (R)36
TemperaturePlaying football in hot environments (L)48High temperatures, especially when accompanied by high humidity, have an adverse effect on performanceDevelop a statement on playing football in hot conditions
Effect of heat on the physical activity of footballers (R)49

  • ACL, anterior cruciate ligament; FIFA, Fédération Internationale de Football Association; NSAIDs, non-steroidal anti-inflammatory drugs; WADA, World Anti-doping Agency.